Messy, Bloody, and of the Past

There is a sort of idealism in certain corners of the mental health space, where alternatives to currently mainstream approaches (e.g., diagnosis, psychopharmacology, inpatient psychiatric care) are presented as if they would be implemented by systems unencumbered by all the obstacles and impediments that weigh down our current systems of care. Considerations related to lack of resources, understaffing, poor training, burnout, moral injury, insurance reimbursements, healthcare bureaucracy, grant funding, quality control, stigma, unintended effects, malpractice litigation, political priorities, and legislative difficulties are often ignored, or barely taken into account, giving the impression that these clinical alternatives will be practiced in a magical realm of virtuous socialism.

In November 2021, in a similar moment of frustration, I tweeted:

“A crucial test for any diagnostic system or therapeutic intervention is how it is or will be implemented in practice by individuals who are overworked, amotivated, cynical, skeptical, poorly paid, under-resourced, and in possession of only a superficial working knowledge.”

This reminds me of a passage from the book Free: Coming of Age at the End of History by Lea Ypi, who is a professor of political theory at the London School of Economics. Free is a memoir of her childhood in communist Albania and her account of living through the end of Communism in the Balkans. In the final chapter of the book, she discusses how during her university education in Italy, her real-life contact with socialism was often dismissed by students and academics who idealized socialism: “they did not think that my stories from the eighties were in any way significant to their political beliefs... “What you had was not really socialism,” they would say, barely concealing their irritation.”